Biomedical subjects
Publications and source records attributed to I Biskup.
The authors describe the case of gastroschisis and Dandy-Walker syndrome of the surviving fetus after the intra-uterine co-twin demise in a monochorionic twin pregnancy.
The authors present gastroschisis which occurred in a surviving fetus after the co-twin demise in a monochorionic pregnancy. They analyze the problems of prenatal ultrasound diagnosis of gastroschisis stressing the adequate planning of delivery with necessary additional diagnostic and therapeutic efforts.
This paper summarizes our experience with Doppler velocimetry in survivors of intrauterine co-twin demise. In the first trimester, ten dichorionic deaths occurred; none of the survivors developed flow disorders. During the second trimester, there were three intrauterine demises, two of them were monochorionic and the survivors developed flow disorders: one presented transitory venous flow aberration, the other one an impaired development of diastolic flow. In the third trimester, two intrauterine deaths occurred. One case of twin to twin transfusion syndrome (TTTS) was complicated by the donor's death and the recipient showed a loss of diastolic flow. The second one happened during a dichorionic twin pregnancy. The survivor presented high systolic/diastolic daily ratio (S/D = 7.8).
Our study reports five cases of prenatal ultrasound diagnosis of nuchal cystic hygroma and early diagnosis for both fetus and mother. We observed that nuchal cystic hygroma is frequently associated to cytogenetic abnormalities, congenital structural anomalies and non-immune hydrops fetus universalis.
The term gestational trophoblastic disease is used to indicate a group of both benign and malignant trophoblast, including molar degeneration of villi, hydatid mole, invasive mole and choriocarcinoma. This study shows a new classification of trophoblastic disease existing with a living fetus or fetuses. Benign hydatid mole is the initial stage of the disease continuum, whereas highly malignant choriocarcinoma is the final stage of this spectrum.
The acute form of twin-to-twin transfusion syndrome is caused by rapid transfer of blood from one of the twins to another via placental anastomoses. Usually, this only occurs during the second stage of labour as a result of a sudden relative rise of blood pressure in one of the fetal circulations. This can result in the sudden intrauterine death of a fetus (or both, as in our case). Currently, there is no reliable means of identifying such an at-risk pregnancy by means of ultrasound antenatally. We would classify this as TTTS Type III.
The diagnosis of abruptio placentae praecox of the second twin is usually difficult. The clinical symptoms may not be evident. The appearance of the new (third) hypoechogenic space, on ultrasound scan, was in our case the only diagnostic clue. It proved to be blood from the abrupted edge of twin B's placenta penetrating the dividing septum. Its characteristic ultrasound image brought forward the idea and namegiving 'boomerang phenomenon' and indeed, it could return like a boomerang as the intrauterine fetal demise, if ignored. This picture could mislead to the conclusion of being the leakage of amniotic fluid or the amniotic sack of the 'vanishing fetus' in primarily triplet pregnancy. The potentially ominous prognosis of abruptio placentae praecox warrants strict supervision of pregnancies with this phenomenon.
A case is presented of HELLP syndrome which developed several hours after normal labour. The increasing disorders in the blood clotting system (DIC) were the cause of a massive intracerebral haemorrhage and death of the patient.